HAND

, Volume 3, Issue 4, pp 297–303

Upper Extremity Size Differences in Brachial Plexus Birth Palsy

  • Donald S. Bae
  • Michelle Ferretti
  • Peter M. Waters
Article

Abstract

The purpose of this investigation was to determine size differences between affected and unaffected upper extremities in patients with brachial plexus birth palsy (BPBP). Forty-eight patients with BPBP underwent measurements of the bilateral upper extremities. Average age at the time of evaluation was 47 months. In addition, patients or families were asked “How important is the difference in arm size and appearance to you?” Active motion was assessed using the modified Mallet classification, Toronto Test Score, and Hospital for Sick Children Active Movement Scale. Correlation between ratios of affected to unaffected limb lengths and girths and measures of active motion were assessed using Spearman’s rank correlation coefficient. Upper arm, forearm, and hand lengths of the affected limbs were, on average, 95%, 94%, and 97% of the contralateral unaffected side, respectively. Upper arm girth, forearm girth, and hand width were, on average, 97%, 98%, and 95% of the contralateral side, respectively. All differences achieved statistical significance (p < 0.01). Furthermore, over 37% of patients or families reported that limb differences were “very” or “extremely important” to them. No statistically significant correlation between age and limb length discrepancy was noted. Furthermore, there were no correlations between upper limb discrepancies and measures of active motion in individual patients. Patients with BPBP and persistent neurological deficits may expect the affected upper extremity to be on average approximately 95% the length and girth of the contralateral limb. These differences do not correlate with patient age or clinical measurements of active movement.

Keywords

Brachial plexus birth palsy Limb discrepancy 

References

  1. 1.
    Bae DS, Waters PM, Zurakowski D. Reliability of three classification systems measuring active motion in brachial plexus birth palsy. J Bone Joint Surg Am. 2003;85:1733–8.PubMedGoogle Scholar
  2. 2.
    Clarke HM, Curtis CG. An approach to obstetrical brachial plexus injuries. Hand Clin. 1995;11:563–80.PubMedGoogle Scholar
  3. 3.
    Greenwald AG, Schute PC, Shiveley JL. Brachial plexus birth palsy: a 10-year report on the incidence and prognosis. J Pediatr Orthop. 1984;4:689–92.PubMedGoogle Scholar
  4. 4.
    Hardy AE. Birth injuries of the brachial plexus: incidence and prognosis. J Bone Joint Surg Br. 1981;63:98–101.PubMedGoogle Scholar
  5. 5.
    Mallet J. Primaute du traitement de l’epaule—methode d’expression des resultats. Rev Chir Ortho. 1972;58S:166–8.Google Scholar
  6. 6.
    McDaid PJ, Kozin SH, Thoder JJ, et al. Upper extremity limb-length discrepancy in brachial plexus palsy. J Pediatr Orthop Am. 2002;22:364–6.CrossRefGoogle Scholar
  7. 7.
    Michelow BJ, Clarke HM, Curtis CG, et al. The natural history of obstetrical brachial plexus palsy. Plast Reconstr Surg. 1994;93:675–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Van Heest AE, House J, Putnam M. Sensibility deficiencies in the hands of children with spastic hemiplegia. J Hand Surg Am. 1993;18:278–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Waters PM. Obstetric brachial plexus injuries: evaluation and management. J Am Acad Orthop Surg. 1997;5:205–14.PubMedGoogle Scholar
  10. 10.
    Waters PM. Update on management of pediatric brachial plexus palsy. J Pediatr Orthop Am. 2005;25:116–26.CrossRefGoogle Scholar
  11. 11.
    Waters PM, Bae DS. Brachial plexus birth palsy: rationale for a multi-center prospective study. Semin Plast Surg. 2004;18:377–84.CrossRefGoogle Scholar
  12. 12.
    Waters PM, Van Heest A. Spastic hemiplegia of the upper extremity in children. Hand Clin. 1998;14:119–34.PubMedGoogle Scholar

Copyright information

© American Association for Hand Surgery 2008

Authors and Affiliations

  • Donald S. Bae
    • 1
  • Michelle Ferretti
    • 1
  • Peter M. Waters
    • 1
  1. 1.Department of Orthopedic SurgeryChildren’s Hospital BostonBostonUSA

Personalised recommendations